Evidence map›Paper›PMID 39558750›Full record

ArticleHospital pediatrics2024

Testing and Treatment Thresholds for Pediatric Pneumonia in the Emergency Department.

Alexandra T Geanacopoulos, James R Rudloff, Sriram Ramgopal, Mark I Neuman, Michael C Monuteaux, Susan C Lipsett, Todd A Florin

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In one paragraph

Article in Hospital pediatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Alexandra T Geanacopoulos *Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
James R Rudloff *Division of Emergency Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
Sriram RamgopalDivision of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Mark I NeumanDivision of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Michael C MonuteauxDivision of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Susan C LipsettDivision of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Todd A FlorinDivision of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Funding

Washington University Institute of Clinical and Translational Sciences (TL1)TL1TR002344 · NCATS · WASHINGTON UNIVERSITY · PI Jay F. Piccirillo · 2017 to 2026
$8.5M
AHRQ HHS T32 HS000063NCATS NIH HHS TL1 TR002344
6 · The paper itself

Abstract

backgroundClinical prediction models for pediatric community-acquired pneumonia (CAP) may standardize management. Understanding physician risk thresholds is important for model implementation. We aimed to elucidate physician-derived thresholds for chest radiograph performance and empirical antibiotic treatment of CAP among children presenting to the emergency department with respiratory illness before and after knowledge of results of a validated clinical prediction model.

methodsPediatric emergency physicians were surveyed through the American Academy of Pediatrics Pediatric Emergency Medicine Collaborative Research Committee and provided 8 clinical vignettes for children with respiratory symptoms. Respondents were asked to indicate their probability of radiographic CAP and choose whether they would obtain a chest radiograph or give empirical antibiotics before and after being provided with the probability of radiographic CAP based on a validated prediction model. We used logistic regression to establish testing and treatment thresholds, defined as the disease probability at which half of physicians acted.

resultsTwo-hundred and eight (44.3%) of 469 physicians completed the survey. Most were attending physicians (96.0%) practicing in a freestanding children's hospital (76.8%). Testing and treatment thresholds for CAP were 17.6% (95% confidence interval [CI] 16.4% to 18.8%) and 66.1% (95% CI 60.1% to 72.5%), respectively, before knowledge of the model-estimated probability. With knowledge of the prediction model, testing and treatment thresholds were 13.5% (95% CI 12.3% to 14.7%) and 58.0% (95% CI 53.2-62.8).

conclusionsWe elucidated physician thresholds for testing and treatment of CAP, which may be integrated into future pneumonia risk models to improve acceptability and incorporation into practice.

Indexed as

Anti-Bacterial AgentsCommunity-Acquired InfectionsEmergency Service, HospitalPneumoniaChildFemaleHumansMalePractice Patterns, Physicians'Radiography, ThoracicAnti-Bacterial Agents

Identifiers

PMID39558750
PMCPMC11609995

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.